Trapped in a Post-Fact Nightmare: infant feeding in the Dunkirk Refugee Camp

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A healthy, exclusively breastfed baby we met in camp. On the same day we met French women knocking on the doors of shelters and offering tins of powdered formula to mothers.

I used to be incredibly naive. I was brought up to believe that our leaders, even if we didn’t agree with their particular brand of political philosophy, generally had our best interests at heart. Us, the people, were their top priority. Within that mindset came the belief that rules, laws and guidelines in all our institutions were based on the best available evidence to ensure that all our systems were as beneficial, benign and effective as possible.

Oh, how childish a universe I lived in. Real life is a damn sight more complicated than that. We don’t live in a ‘post-facts’ world, we have ALWAYS inhabited a place where facts don’t matter. No, not one jot. Why do we need facts when opinion, habit, cultural norms and prejudice will do just fine?

Sometimes realisations come crashing in on one’s comfortable little life like tsunami waves. Regular readers of this blog with know that recently, I’ve been knocked off my feet by a few corkers.

The first was the dawning awareness that our leaders are able to conveniently ignore the suffering and death of human beings fleeing bombs, hunger, torture and human rights abuses.

The second was that many people seemed able to reframe these people in their minds as somehow less than human; as criminals, animals, leeches, whose only goal is to benefit from our riches because they are too lazy to make their own countries habitable. The facts of war, murder, starvation, rape, the loss of all normality and humanity seemed lost on so many people; a gaping chasm where empathy should be.

A problem so huge: how could I ever hope to be of use? As always, I look for places I can use my existing skills and find time I can devote. I have a strong belief that even small acts can make a difference. So I went to Dunkirk, inspired by my friend Lindsey Middlemiss, who had been working so tirelessly to improve conditions in the camp for mothers and babies, with particular emphasis on infant feeding safety.

I am a breastfeeding counsellor. Yes, I know that, to some, that sounds like a weird job. It’s not a job. It’s a training I undertook because I wanted to volunteer my time to help mothers. I was paying it forward. A reaction against the lack of information and practical help that I had experienced and that I saw all around me. A standing up and being counted. A positive step to shed light on an invisible problem – of new mothers being forgotten, misled and misinformed. The training was rigorous and evidence based. It taught us to centre down on the needs of the mother – to listen carefully to her concerns and provide facts and choices, enouraging her to do what feels right for her and her family. I have supported new families for 13 years now and I’ve learned a thing or two about what mums and babies need. We are not health professionals but as counsellors, our credentials and experience are recognised by all the experts in the field of infant feeding.

Of course, Breastfeeding Counsellors are used to being ignored. We’re used to people understandably being a bit ignorant about what we do. That’s OK. You’re forgiven. If you aren’t lactating or living with someone who is, why should you care? But it would be so very much easier for everyone if, at the very least, health professionals could get up to speed on the facts around infant feeding. Not just because it’s nice if mums can breastfeed if they want to,

but because sometimes, it saves lives.

La Liniere refugee camp is a stark reminder for me of what can happen when people aren’t willing to be guided by the best possible available research evidence and are unable to accept international best practice, based on the experience and hard-won wisdom of experts in the field. The midwives in the camp are volunteers on a two week rotation. They are affiliated with an organisation called Gynecologie Sans Frontieres. For some reason that has not been adequately explained, the French Government will only allow French NGOs into camp.

Until the Calais and Dunkirk Infant Feeding Team (a small group of volunteer Breastfeeding Counsellors) arrived in camp, the midwives were not taking an active interest in the nutrition of the babies in the camp. Much of the work was being done by young volunteers in the woman’s centre who have no knowledge or experience of how to handle infant feeding in emergency situations.

This formula had been open for weeks and kept in a damp, unclean environment

Let’s make this very clear and as simple as possible:In emergency situations, without easy access to hot water, sterilising equipment, long term supplies of milk and regular support for the mothers, bottle-feeding babies with powdered formula is dangerous – potentially fatal. Powdered formula is not sterile. It needs to be mixed with very hot water to kill the bacteria. Bottles and teats need to be cleaned and sterilised after every use. Supplies need to be kept cool and dry, with instructions in the native language of the mother and provided to mothers who actually need it, not sold on black markets to unwittingly undermine the milk supply of breastfeeding mothers who may believe it is better for their babies.

Formula needs to be made up with clean water. In the correct amounts – not watered down because the mother does not have a guaranteed supply. If these provisions are not possible, babies can die – of gastro-enteritis, water-borne diseases or even starvation if mothers are eeking out supplies.

THIS IS NOT MY OPINION. These are the facts. Facts agreed on by every major health organisation and NGO working in areas of deprivation and emergencies situations around the world. Facts agreed by the World Health Organisation.

But facts, it seems, don’t apply to GSF.

Remember, these women and babies are living in cold, damp wooden sheds. They do not have a sink or hot water on tap. They do not have sterilisers or enough clean bottles to last even one day. Everything you think you know about bottlefeeding a baby is different when living in those conditions.

So I am asking myself a difficult question: why do the facts not seem important to the midwives working in the Dunkirk camp? A camp with minimal facilities for heating water, washing equipment or keeping tins of powder clean and dry? Do the realities of the rest of humanity not apply to the French? Apparently not, as I was told to my face that “maybe English formula has bacteria in it, but French formula is safe”. I was also told that the fear of being impolite to people donating powdered formula is more worrying than the health risks to babies.

We have tried, til we are blue in the face, to explain that we are not saying formula should not be used.

WE ARE NOT ABOUT RESTRICTING MOTHERS’ FREEDOM OF CHOICE.

We are about making sure mothers have the facts so they can make fully informed decisions.

But this appears to be beyond the ability of the midwives to accept. Despite our best efforts to persuade them that they are not following best practice, despite our assurances that we are not interested in forcing mothers to breastfeed, they insist they are right and we are wrong. Yet again, opinion trumps fact.

The crazy thing is that small changes can make a massive difference. Most of the refugee mothers in Dunkirk are Iraqi Kurds who culturally usually breastfeed. They WANT to breastfeed. A little bit of reassurance, positivity and a reminder that they don’t need formula, even though they may see French mothers doing it. That it’s not better or necessary to give it to their babies.

For mothers who need or freely choose formula, ready made up, liquid formula has been pasterised so it’s much safer. Babies can be fed with a cup, which are easier to wash up (no small, hard-to-reach parts that are breeding grounds for pathogens). All mums can be given a full feeding assessment and gentle, appropriate guidance and information given, in their own language, so they can make decisions about how they feed their babies, free from coercion and as safely as possibly, given their living conditions.

I thought, after a friendly meeting with the midwives, that we understood each other. I thought there was mutual respect. I was wrong. The attitudes towards infant feeding are so deeply culturally embedded that they risk harming the very children they wish to protect and serve.

And you know, it’s not the midwives I blame. They can’t help their training. They can’t help that there is zero guidance from GSF or their own regulatory body on appropriate infant feeding in emergency situations. No, I blame GSF. I blame the French Government for taking no interest whatsoever in the quality of provision for these incredibly vulnerable people who are their guests. And I blame the British Government who, despite multiple visits from MPs, have failed to put pressure on the French government to improve conditions or bothered to actually find and look after the refugees who we have already agreed to accept into the UK.

We can no longer look away and pretend this crisis is going to go away on its own.

At the very least, if the French authorities would let in NGOs like Save the Children, and held GSF to account, the health and well being of the most vulnerable in the camp would be massively improved and perhaps lives saved.

Improvements that have been achieved:
~The Woman’s Centre staff and the midwives are now working together. Joined up thinking we have been calling for for months.
~The midwives are apparently minimising the use of powdered formula and asking for donations of liquid in cartons.

Things that need improving:~GSF needs to commit to following WHO guidance on IYCFE and provide adequate training to midwives and others working with mothers and infants/young children.
~The midwives are still asking for ‘follow on’ (stage 2) which is more expensive and nutritionally completely unnecessary and potentially dangerous if mistakenly fed to babies under 6m.
~Labels in the mothers’ own languages need to be attached to the formula cartons.
~Volunteer groups should not be free to distribute powdered formula directly to mothers.
~An understanding that volunteer breastfeeding counsellors provide vital peer support to mothers, have a solid understanding of lactation and training in infant feeding in emergencies and should be welcomed into camp to talk to mothers. Not so we can coerce or shame them into breastfeeding (jeez I am so tied of that old chestnut) but to support them in finding the way that both suits each mother best and is the safest possible given the circumstances. This requires counselling skills, time, experience and sensitivity.

What you can do:
~Ask your MP to read this blog and find out what plans there are for improving conditions in the Dunkirk camp. Despite even harder conditions, camps in Greece have been following international best practice to great effect so it can be done. Call on your MP to hold NGOs accountable for the way they care for vulnerable mothers and infants.
~Share this blog on social media and call for GSF to follow IYCFE Guidance (Infant & Young Child Feeding in Emergency)
~Get informed – everything you may need on infant feeding in an emergency can be found on the Safely Fed website.

One more time:
we’re not interested in coercing women.
We don’t think mothers should be made to breastfeed.
We DO think the facts are important when it comes to the health of tiny babies living in appalling conditions.

Comments

I completely agree that it’s almost criminal to promote formula in this way in these conditions so I’m happy for this story, although it’s so sad, but… this whole daily-sterilising-thing is old-fashioned nonsense!
The author states: “Bottles and teats need to be cleaned and sterilised after every use.” It might in these particular conditions be wise to sterilise because it’s damp in the camp, but then it would be wiser to do that just befóre every feeding, not áfter every use when the bottles and teats can get damp/dirty again in the hours afterwards.
But then, I guess I’m not allowed to discuss this cultural habit because everything is stated as facts.

Perhaps I should have been a little more detailed: you are right – the bottles need to be cleaned thoroughly after use and placed in the cold water steriliser to ensure they are kept clean until the next use. This is particularly important in camp conditions. It’s important for new babies even in secure living conditions…I’m not sure it’s just a cultural habit? NHS guidance is definitely to sterilise…
Thanks so much for your comment – sharing views is so important! Love, the author 🙂

I work for Medecins Sans Frontieres (MSF) and we wanted to clarify some key points in this article.

MSF has never employed midwives to work in the Liniere camp at Dunkirk. We would also never use volunteers for a couple of weeks at a time – our staff are on 6 – 9 month contracts. There are a number of other organisations working at the camp, some of whom may well employ or use volunteer midwives but we of course can’t comment on their actions and have not been witness to what you’re describing.

MSF in fact left the Liniere camp altogether in September 2016 as the number of refugees and migrants there fell to around 800. We handed over our small clinic there to the french local authorities.

MSF did build the Liniere camp in January-March 2016 in partnership with the local mayor for Dunkirk. This was in response to an emergency situation as 2,500 people were ‘living’ on marshland, which regularly flooded, surrounded by piles of rubbish and rats. We were seriously concerned for people’s welfare and agreed to urgently move people to a drier piece of land and construct temporary shelters for them. The local french authorities agreed from the beginning that they would be responsible for the running of the camp and for finding a long term solution for the people trapped there.

Please do let me know if you have any questions or would like more information

For regular readers of this blog and to clarify the above comment – there was understandable confusion between two completely separate charities, MSF and GSF. The blog has now been edited to remove all mention of MSF, who left the camp in September 2016, since which time the midwifery care has been provided by the smaller and lesser known charity GSF. We will be continuing to call for GSF to adhere to internationally agreed humanitarian standards in Infant Feeding in Emergencies.